It’s nearly 2 years since the UK entered the first national lockdown due to SARS-CoV-2. Back then, attention was primarily focused on minimising and managing acute infection. As the pandemic has progressed however, it has become increasingly apparent that there is significant potential for longer-lasting effects and it is now recognised that high numbers of people are experiencing health effects lasting well beyond the initial period of acute illness. In addition to minimising and managing acute infection, Long COVID or Post-COVID-19 syndrome has become an important focus. More than 50 different potential long term effects have been identified, with the most commonly reported including breathlessness, headaches, cough, fatigue (even on minimal exertion), loss of taste and smell, generalised muscle and joint pains, cognitive impairment or ‘brain fog’, sleep disturbances and mood alterations.

Understanding the terms:

Acute COVID-19: Signs and symptoms of COVID-19 for up to 4 weeks.

Ongoing symptomatic COVID-19: Signs and symptoms of COVID-19 from 4 weeks up to 12 weeks.

Post COVID-19 syndrome: Signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body. Post-COVID-19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed.

Long COVID: In addition to the clinical case definitions, the term ‘Long COVID’ is commonly used to describe signs and symptoms that continue or develop after acute COVID-19. It includes both ongoing symptomatic COVID-19 (from 4 – 12 weeks) and post-COVID-syndrome (12 weeks or more).

Optimising nutrient intake - “just as relevant for Long COVID as any other health problem”.

There is still much we don’t know and ongoing research is needed to better understand the longer-term impacts of COVID-19. As always however, there is a lot that can be done to support the bigger picture of health. What we do know for sure is that optimising nutrient intake is just as relevant with Long COVID as for any other health problem. There is no one size fits all solution, there are however some key nutrients and ingredients that are worthy of consideration:

Top 5 nutrients & ingredients to consider:

1. Vitamin A
Vitamin A is an essential fat-soluble vitamin which supports many vital health functions and plays an important role in both immune function and the regeneration of olfactory receptor neurons. In a 2017 study, German researchers found intranasal vitamin A at a dose of 10,000 IU per day for 2 months to be useful in the treatment of post-infectious olfactory loss.1Now, researchers at the University of East Anglia and James Paget University Hospital have launched The Apollo Trial to evaluate whether vitamin A could help people to regain their sense of smell after viral infections including COVID-19.2

2. Zinc
Some of the lasting effects of Long COVID may in part be due to inflammation that persists beyond the acute infection, which often co-occurs with blood sugar dysregulation. Zinc is involved in pretty much every aspect of health including immune function, antioxidant activity, inflammation balance, taste, smell and blood sugar balance and thus is a key nutrient to consider. Zinc is not stored in the body so regular dietary intake is needed, yet levels may typically be low in a Western diet. Ensuring optimal daily intake of zinc is therefore key. Additional zinc can be taken as a dietary supplement in highly bioavailable forms such as zinc picolinate, bisglycinate or citrate.

3. Omega-3s
We need both omega-6 and omega-3 fats in our diets. Omega-6 fats are more associated with ‘pro-inflammatory’ effects, whereas omega-3s tend to produce more ‘anti-inflammatory’ effects. Since persistent inflammation may be an underlying factor in Long COVID, it seems prudent to pay attention to the relative balance between these two. Sadly, modern Western diets tend to contain much more omega-6 than omega-3; in fact, the dietary ratio of omega-6:3 has increased from around 4:1 in our hunter-gatherer ancestors to around 20:1 today. And we know that this can have negative effects on health. A study published in the American Journal of Clinical Nutrition in 2021 found blood levels of omega-3 fatty acids EPA (eicosapentaenoic acid) & DHA (docosahexaenoic acid) to be very good predictors of mortality risk3.  Lead author of the study Dr Aleix Sala-Vila commented, "having higher levels of these (fatty) acids in the blood, as a result of regularly including oily fish in the diet, increases life expectancy by almost five years”.

Omega-6 fats are found in grains, refined vegetable oils such as corn, safflower and sunflower and grain-fed meat whereas omega-3 fats are found in flax, hemp & chia seeds, walnuts, grass-fed meat and oily fish such as salmon, mackerel and anchovies. Oily fish is considered to be the best source of omega-3s, however can commonly be contaminated with toxins such as heavy metals and PCBs. It is generally recommended that the most effective way of adding more omega-3s into your diet is with a daily supplement of omega-3-rich fish oil that has been sustainably sourced and thoroughly purified to remove any contaminants.

4. N-Acetyl-L-Cysteine
N-Acetyl-L-Cysteine is a semi-essential amino acid which has been found to be useful in the management of respiratory conditions and for supporting immune health. One of its main functions in the body is as an ingredient to make glutathione - an essential compound for fighting cellular damage, supporting balanced inflammation and optimising immune health. Glutathione is often nicknamed the master antioxidant. NAC may help to relieve symptoms of respiratory conditions by reducing inflammation and loosening mucous in the airways, thus improving overall lung function. NAC is a useful daily supplement for everyone; and particularly in the elderly due to the fact that plasma cysteine and glutathione levels tend to decline with increasing age. You can also supplement directly with glutathione for more targeted support. Glutathione works well with green tea, selenium, milk thistle, curcumin and alpha lipoic acid.

5. Curcumin
Last but not least, curcumin deserves special mention of its own, not least for its powerful antioxidant and anti-inflammatory activities. Often referred to as ‘Indian Saffron’ due to its characteristic bright yellow colour, turmeric has been used as a traditional Ayurvedic health remedy and culinary spice for more than 4000 years. Curcumin is the main active component of turmeric, and delivers many health benefits. It is best known for powerful and widespread anti-inflammatory and antioxidant activity and research has shown that curcumin has the ability to modulate many inflammatory pathways in the body. This makes it an important consideration for any health problem where persistent inflammation may be an underlying cause. Curcumin can be added to the diet via the spice turmeric which is best consumed with a source of fat as it is better absorbed this way. Curcumin can also be safely taken in supplement form for more targeted support. Rutin, quercetin, rosemary, ginger and vitamin D are all important for inflammation balance too and work well combined with curcumin.

1. Hummel T, Whitcroft KL, et al. Intranasal vitamin A is beneficial in post-infectious olfactory loss. Eur Arch Otorhinolaryngol. 2017 Jul; 274(7): 2819-2825.
3. Michael I McBurney, Nathan L Tintle, Ramachandran S Vasan, Aleix Sala-Vila, William S Harris. Using an erythrocyte fatty acid fingerprint to predict risk of all-cause mortality: The Framingham Offspring Cohort, The American Journal of Clinical Nutrition 2021

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